Second, whether we like it or not, managed care has forced a level of integration into some health care delivery systems that wouldn't have done it otherwise. They’ve done it because they’ve got patient demand, they've got market forces, and also in some cases because they think it's the right thing to do.

REDWOOD: Do you mean that when patients ask their primary care physician (PCP) for a referral to a chiropractor, in a situation where that referral is required in order for the patient to be reimbursed by insurance, that the PCP is more likely say yes than would otherwise be the case?

MEEKER: Yes. Kaiser in California finally said yes to including chiropractors. The integration at the delivery system level is starting to happen. That process has not been very comfortable, but it's definitely happening.

REDWOOD: When it comes to integration in research, you have some non-chiropractic institutions in the CCCR.

MEEKER: We do. We have a number of departments at the University of Iowa, the School of Veterinary Medicine at Kansas State University, and the Bioengineering Department at the State University of New York at Stony Brook. There are also six chiropractic colleges involved—Palmer, National, Western States, Northwestern, Los Angeles, and Canadian Memorial.

REDWOOD: So integration is beginning to happen not only at the doctor-to-doctor level in practice, but also in research. And there is now, for the first time, a chiropractor, Christine Goertz, who is employed full-time at NIH at the National Center for Complementary and Alternative Medicine.

MEEKER: Yes, and Dr. Lisa Killinger, who is on our faculty here at Palmer, is a consultant to the Health Resources and Services Administration (HRSA). So yes, we now have at least 2 chiropractors working in official positions in the government.

REDWOOD: You serve on the advisory board of the National Center for Complementary and Alternative Medicine, as does another chiropractor, Dana Lawrence. What have you found most encouraging there? And what, if anything, has been discouraging or challenging?

MEEKER: It's been quite a learning experience for me just to figure out how the machinery of NIH works. The policies, the procedures, the politics, the whole nine yards. NIH has a very distinct culture. I think, encouragingly, that there's a real commitment at NIH to pursue CAM research, and it's very clear that chiropractic is in that picture. I’ve been made to feel very welcome in that regard. Steven Strauss, the director of NCCAM, deserves some real credit. I liked Wayne Jonas, and I'm sorry he had to leave. But Steve Strauss has more clout within NIH. He’s fair, he’s competent, and he’s a highly respected scientist, who seems to be very energetic and very dedicated to NCCAM. I think he does listen to the council, which is a bit of a strange animal as NIH councils go, because Congress mandated that it include such a large proportion of non-MD practitioners. They don't normally legislate that to the degree they did in this case. It caused some concern at NIH, but it's worked out pretty well. We’re still evolving as a council; we still have some things to learn.

I am very encouraged by the fact that the money is coming in, the fact that they’ve hired Christine Goertz, and the fact that next year they’re likely to get even more money than the current annual budget of $70 million. Also, the fact that they’ve designed funding mechanisms that we can take advantage of, training-wise and project-wise.